MEDICARE: MRS. VANESSA DEJILLO ACOSTA PT,DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501013824	MI
2	225100000X	Physical Therapist	3815	NM
3	225100000X	Physical Therapist	PT32443	FL

General Provider Information

NPI Number	:	1316261175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA DEJILLO ACOSTA PT,DPT

Provider Business Mailing Address
First Line	:	3563 PHILIPS HWY STE 202
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5627
Country	:	US
Telephone Number	:	618-303-1323
Fax Number	:

Provider Business Practice Location Address
First Line	:	3563 PHILIPS HWY STE 202
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5627
Country	:	US
Telephone Number	:	618-303-1323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2010
Last Update Date	:	10/02/2019

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